Videotaping an advance directive, the
researchers explain in an article recently
published online in the Archives of
Geriatrics and Gerontology, would allow
people to express medical decisions to their
physicians and families in a way legal
documents do not allow – face to face.
“Studies have shown that advance directives,
in spite of the idea that we should honor an
incapacitated person’s wishes, just simply
don’t work very well,” Moseley said.
“There’s this growing frustration out there
that written advanced directives aren’t
working and there don’t seem to be any
alternatives. We’re offering an
alternative.”
Moseley said the problem isn’t the message
of advance directives, which have been used
for about 30 years and allow people to plan
ahead for their health care should they
become seriously ill.
Advance
planning can keep people from battling about
end-of-life decisions in court, like the
family of Terri Schiavo, a Florida woman in
a persistent vegetative state whose husband
and parents fought for years about whether
her feeding tube should be removed.
But a written advance directive doesn’t
always stop the bickering among families,
Moseley said.
Seeing a relative explain his or her
decision in a video could quell some of the
discord, the researchers suggest.
A videotape could spur discussions at home
about death, too.
“None of us like talking about end-of-life
issues,” he said. “We are a death-denying
culture. But that’s only one little part of
(the problem). The big part of it is the
medium.”
A written advance directive often raises
more questions for doctors than the document
answers.
Physicians don’t always know if their
patients were coherent when they signed the
form or what they meant by certain terms
like “terminal.”
And many physicians in hospitals are caring
for incapacitated patients they’ve never met
before, let alone when they were healthier
and still coherent.
This confusion about a life-or-death issue
can force doctors to make conservative
treatment choices, ones that may not
coincide with what a patient expressed in an
advance directive, Moseley said.
“Some of the most difficult situations –
difficult for families, patients and
physicians – revolve around advance
directives,” said Robert Hatch, M.D., a UF
associate professor of medical education who
contributed to the report along with another
researcher from the University of California
at Los Angeles.
Hatch said a doctor with a full hospital
schedule probably faces an advance directive
problem every other month.
Most doctors are uncomfortable relying on a
legal document to determine whether a
patient lives or dies, said Kenneth Goodman,
Ph.D., a University of Miami bioethics
professor and the director of the Florida
Bioethics Network.
But with technological and medical advances
keeping patients alive longer than they did
50 years ago, advance directives are
becoming increasingly important, he said.
“Advance directives are a very important way
to let your wishes be known,” he said.
“(Video) is a very creative way of
demonstrating what you want. I think it’s a
good idea.”
The researchers don’t think the written form
of advance directives should be scrapped
though.
They see video as a supplement. While many
states would accept a video, some states
require an advance directive be signed to be
legally binding.
In Florida, an advance directive does not
have to be written but must be witnessed to
be legal.
Moseley notes that video living wills may
not solve every problem.
He said he thinks the idea needs to be
studied further and people need to learn to
accept others’ wishes so a patient’s rights
are never violated. But for most families
and doctors,
Moseley said video is one step closer toward
a conversation and potentially, one step
closer toward acceptance.
“Our goal should be to honor a patient’s
wishes as best we can, and a video living
will would significantly help,” he said.
... ..
...
...
